Brachialgia (cervical radiculopathy)
Brachialgia: key points
The term "brachialgia" defines a painful condition at the level of the arm, due to crushing or irritation of a spinal nerve in the neck.
In addition to the cervical pain radiating along the arm, the patient suffering from brachialgia complains: scapular and cervical pain, weakening and loss of muscular strength of the arm, tingling and perception of electric shocks to the hand and arm.
In the case of brachialgia, the patient is invited to undergo a series of diagnostic tests, useful for tracing the cause of the disorder: medical history, medical observation, imaging test (CT scan, magnetic resonance), electromyography.
The choice of a treatment rather than another depends on the cause responsible for brachialgia; treatment options include: discectomy, foraminotomy, laminectomy, and compromised cervical disc replacement. In mild cases, brachialgia can be attenuated simply by taking pain medication and anti-inflammatory drugs.
The terms brachialgia and cervical radiculopathy are synonyms used in the medical field to identify any painful condition, at arm level, due to crushing or irritation of a spinal nerve in the neck. The nerve roots most commonly affected by brachialgia originate from the C7 vertebrae (60% of cases) and C6 (25%).
Among young people, brachialgia is often a consequence of a cervical disc hernia. In older patients, on the other hand, neuropathic arm pain is generally caused by a narrowing of the foraminal and spinal canal (conducted in the spinal column within which the roots of the spinal nerves and the spinal cord itself flow).
Brachialgia is a symptom found in numerous pathological conditions:
- Degenerative changes in the intravertebral joints
- Cervical osteoarthritis
- Cervical disk hernia (most frequent cause of brachialgia among young people)
- Degenerative diseases of the cervical disks
- Osteophytes (bone spurs): these are bony growths located on the same surface as the bone. The disorder - typical of joints - is due to an exaggerated accumulation of calcium on the articular cartilage.
- Progressive disc degeneration, often caused by the inexorable aging process
- Intervertebral prolapse
- Spinal stenosis
- Spine tumors
It is not uncommon for two or more pathological conditions listed above to occur simultaneously.
A patient is more exposed to the risk of brachialgia during recurrent spine infections, heavy work, power sports (weight lifting) and smoking.
In order to keep the cervical and spine muscles in general in good condition, it is essential to always assume a correct posture. Cervical spine and brachialgia alterations are not only caused by violent movements and heavy work: even staying in front of the computer for many hours a day does not help the spine. Incorrect postures, especially when kept for a long time, can favor muscle spasms in the cervical area of the spine, inevitably causing more or less marked suffering in the intervertebral discs.
The patient suffering from brachialgia experiences a series of unpleasant sensations in the area innervated by the nerve root involved (see figure). The pain that radiates along the arm can also involve the scapular and cervical area, often alongside paresthesia, weakening and loss of muscle strength. Brachialgia can also alter the sensitivity of the skin of the arm to the compromised nerve: the patient perceives a reduction in sensitivity to mechanical skin stimuli, up to complete cervicobrachialgia (muscle weakness of the arm associated with persistent cervical pain).
A patient complaining of continuous cervical pain spread along the arm must undergo diagnostic investigations, useful for shedding light on the cause of brachialgia. In fact, only after having isolated and identified the origin of the pain is it possible to proceed with a targeted and specific care. The investigative exam consists of a series of tests, such as:
- Medical history, observation and palpation: the patient suffering from brachialgia tends to tilt the head from the side of the nervous lesion and to keep the neck stiff.
- Cervical spine imaging test:
- X-ray (X-ray): offers a general view of the bones and tissues of the neck
- CT ( Computerized Tomography ): detects any structural-bone alterations of the cervical spine (eg acute fractures / herniated discs) responsible for brachialgia
- CT + myelography: this combination of analytical tests is able to assess the severity of a possible injury to the cervical spine, also identifying the precise location of spinal cord compression
- MRI ( Magnetic Resonance Imaging ): first choice investigative test to detect possible pathologies affecting soft tissues (eg herniated disc)
- Electromyography: patients who complain of brachialgia can also undergo electromyography, a useful test to detect nerve root anomalies and exclude other possible neurological causes
There are numerous possibilities of intervention to correct the pain derived from brachialgia: the choice of a cure rather than another clearly depends on the cause that gave rise to the disorder.
The administration of pain-relieving drugs temporarily attenuates and masks the pain: for this purpose, NSAIDs, opioids and sometimes anticonvulsants, are the most used in therapy.
When the pain is fierce and heavily compromises the normal work-social activities of the victim, the doctor can suggest the injection of anesthetic substances directly into the nerve involved in the disorder; this inoculation of drugs is performed under the radiological guidance of a CT scan. After the procedure, patients often declare themselves enthusiastic because the pain derived from brachialgia tends to decrease considerably; the only disadvantage of this therapy is that the anesthetic effect wears off after a few days, and the pain comes in equal intensity.
For further information: Medications to treat Brachialgia »
Parallel to drug treatment, the patient suffering from brachialgia can get relief from adequate physical-conservative therapy, which can include physiotherapy, targeted massages, acupuncture and osteopathy.
Where the therapies just described were not sufficient to alleviate and remove brachialgia, the patient is generally subjected to surgery, subject to the triggering cause:
- Discectomy: indicated when brachialgia depends on a herniated cervical disc. The intervention consists in removing the herniated disc by incision in the neck. Subsequently, the disc is replaced with a small bone fragment extrapolated from the patient's own pelvis.
- Foraminotomy: intervention indicated to alleviate the pressure exerted on the compressed nerves within the intervertebral foramen
- Laminectomy with or without fusion: surgical removal of the lamina of one or more vertebrae involved in the lesion. In this way an opening of the vertebral canal is obtained which allows correcting any malformative / traumatic pathologies responsible for brachialgia.
- Replacement of the damaged cervical disc with a prosthesis
It is the duty of the neurosurgeon to direct the patient suffering from brachialgia towards the most suitable surgical treatment.